New York's Hamilton County is rural, remote and Republican. It also has one of the highest vaccination rates in the country.
In general, vaccine hesitancy is estimated to be higher in rural areas, according to an ABC News analysis of county-level data. Counties with high estimated hesitancy also tend to be younger, poorer and more likely to have been won by former President Donald Trump during the 2020 presidential election.
Hamilton defies several of those trends. The county is "very, very rural," according to Bill Farber, the county's board chairman, with a year-round population of fewer than 5,000 residents nestled among the mountains and lakes of New York's Adirondack Park. It's isolated, with infrastructure and technology challenges, including spotty broadband and cell service. There's no hospital nor pharmacy in the county. During a pandemic that's been heavily politicized, it leans Republican, with 68% of residents voting for Trump in the 2020 election.
And yet an impressive 65% of people in the county are fully vaccinated against COVID-19, compared with 36% of Americans nationally, according to the Centers for Disease Control and Prevention.
"We've watched nationally, this political fight over COVID," Farber said. "We defied the odds, didn't we?"
Hamilton managed to sidestep that fight when it came to vaccines in part, he said, because its campaign was driven by the community and involved so many of its members. Schools, as well as a fire house, became vaccination sites. Business owners provided the county with lists of their employees as soon as they were eligible to be vaccinated. Local volunteers and neighbors spread information about the vaccine and talked about how excited they were to have protection against the virus. Hearing from trusted friends and family influenced the attitude of the community, according to Farber.
"That type of localized community conversation is so powerful in educating people, particularly in this day and age when people are so suspicious of politics and government," he said.
In addition to decoupling politics from public health, Hamilton benefited from having a plan in place when COVID-19 hit. Many small, rural communities don't have public health departments, but Hamilton does, and had a pandemic plan in place for more than a decade, which involved partnering with schools, the fire department, ambulance squad, law enforcement and community leaders.
When Adele Burnett, director of tourism in Inlet, one of the small towns in Hamilton, heard that the health department needed help registering people for vaccines, she jumped to volunteer. She and other members of the local COVID-19 task force compiled lists of people they knew were eligible to get vaccinated and called to see if they could register them for vaccines.
"We'd actually pick up the phone and start making calls," she said. "They didn't have to sit there on the computer refreshing the page."
In addition to helping residents overcome technology barriers, the county tried to accommodate people's work schedules by offering vaccine clinics in the evening and on Saturdays. When new cohorts of people became eligible, like restaurant workers, the county tried to tailor clinic hours to target that group, Farber said.
Hamilton's older population and high number of front-line workers, like teachers, first responders and restaurant workers, also meant residents were eligible for vaccinations early in the state's rollout.
Now, like many places in the country, vaccinations in Hamilton are slowing and the county is looking for new ways to engage the unvaccinated. In addition to partnering with schools to get shots to newly eligible teenagers, the county plans to offer them in grocery store and gas station parking lots, as well as at farmers markets.
The county is also looking ahead to summer when Hamilton's population swells as second home owners and tourists flock to the area for boating, fishing and hiking. They're partnering with employers, Farber said, to offer vaccines to seasonal employees at kids summer camps.
Despite those efforts, Farber and Burnett acknowledged that getting to 100% vaccination was highly unlikely, even in Hamilton, and that pockets of people would probably remain unvaccinated. Still, Farber thinks this week's CDC announcement about mask wearing for fully vaccinated people could encourage some of the holdouts.
Rewarding people for getting vaccinated instead of forcing them to get a shot they're resistant to is in line with the apolitical ethos that's driven Hamilton's successful vaccine rollout thus far.
"Rather than getting caught up in it being a Republican or a Democrat issue, it really was seen as a community issue," Farber said. "I think that was our saving grace."
ABC News' Mark Nichols contributed to this report.